Managing COVID-19 related Trauma - May 7, 2020 - Autism Science ...
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Managing COVID-19 related Trauma
May 7, 2020
Dr. George Ake Dr. Jeffrey Lieberman
Guidelines for today: • You are all on mute, no video. Go wild! • Use the question box for questions or comments • Webinar will be recorded and posted • You send questions to me, I will pass them on anonymously • ahalladay@autismsciencefoundation .org
Points for discussion • How can you describe what is going on? • Is it PTSD? Does it have the potential to be? • What can we do to help mitigate trauma? • What resources exist?
Managing COVID-19
Trauma-Informed Approaches
George “Tripp” Ake, Ph.D.
May 7th, 2020
Acknowledgements • Melissa Brymer, PhD • Katelyn Donisch, PhD • Robin Gurwitch, PhD • Angela Tunno, PhD • National Child Traumatic Stress Network • Duke University Medical Center • Center for Child and Family Health
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Agenda • Definitions of acute, chronic, complex trauma and comparison to COVID-19 related stress • How can caregivers make a difference? • Introduce a trauma-informed approach to help take care of: • Children • Families • Provide Resources on COVID-19
Types of Trauma Acute trauma: A single event that lasts for a limited time
Types of Trauma Chronic trauma: The experience of multiple traumatic events, often over a long period of time
Types of Trauma Neglect: • Failure to provide for a child’s basic needs • Perceived as trauma by an infant or young child completely dependent on adults for care • Opens the door to other traumatic events • May reduce a child’s ability to recover from trauma
When Trauma Is Caused
by Loved Ones
The term complex trauma is used to describe a specific
kind of chronic trauma and its effects on children:
§ Multiple traumatic events that begin at a very young age
§ Caused by adults who should have been caring for and
protecting the child
Sources: Cook et al. (2005). Psychiatric Annals,35 (5), 390-398;
van Der Kolk, C. A., & Courtois, B. A. (2005). Journal of Traumatic Stress, 18, 385-388.COVID-19: A Different Kind of Crisis • Infectious disease outbreaks are very unique and may not fully fit into how we view other traumatic or distressing events • Chronic crisis with insidious stressors that are chronic, silent, and impactful on multiple levels • Some examples of potential stressors: • Health of loved ones • Health of self • Separation from family • Food insecurity • Job insecurity • Moral duress • Anticipatory and/or traumatic grief • Vicarious trauma through media exposure • Others?
Already Seeing Confusion Around How To Talk About Trauma and COVID-19
COVID as an ACE
Collective Trauma
Pre-Trauma
Response to Stressor
Mass Community
Disaster
Ake, 2020Framework For Examining
Impact of COVID- Related COVID -Death
Stress Exposure to
COVID-Individually
or in Family
Difficulty with Food Access
and Medical/Mental Health
Care Accessibility
School/Job Changes or Losses, Family
Income Changes
Baseline Stress for all (worry about getting sick, Adapted from
trips to grocery store, loss of routine, loss of Stoddard and
Kaufman, 2020
connection to family, friends, social connections)Key Phrases of Danger and Safety
• Families are enduring times of danger right now
• We need to approach this with appropriate appreciation for how changes
and losses related to COVID impact mental health for so many and how,
depending on the circumstances, people may experience a trauma (e.g.,
traumatic loss of a loved one, maltreatment in a home during lockdown,
• We need to also be careful to avoid making large generalizations that large
groups of people will be diagnosed with Posttraumatic Stress Disorder
• Focus on Safety
• First thinking about how kids and families might be physically safe
(including the invisible risks associated with being in contact with others)
• Next really need to be thinking about how to maintain psychological
safety for all at homeNegotiating
Danger and Safety
Issues
Pre-Existing
Trauma
History/Symptoms
Increased Risk for
Increased
Frequency,
Impairment of
Intensity, and Functioning and
Duration of COVID Need for Mental
stressors Health Services
Overall COVID-19
Stressors• Many versions of this being circulated • Generally Good to Promote Perspective Taking • Careful to Not Communicate Judgement (e.g. choosing fear or learning, or growth vs. no control over these things)
How Can Caregivers Make a Difference?
Taking Care of Children
• Find the most developmentally appropriate way to share about
COVID-19
• Important to convey a sense of calm
• Kids will be looking to you to see how to respond
• Model healthy ways of coping and acknowledge limits
• Don’t make promises you can’t keep re: COVID
• Ensure your basic needs are met
• Eating nutritious food, staying hydrated, sleeping, social connection –
integrate these into your daily routine (no guilt, no apologies)Taking Care of Children
• While it can really be challenging, try to find ways to restore
some routine and structure
• Maintain meal and bed times
• Maintain rules and expectations
• Maintain routines for connecting (maybe virtually) with peers as
appropriate
• Maintain any services that can be delivered virtually
• Stay connected with your supports
• Find supportive adults to talk withHelping Caregivers Explain COVID-19 to
Children
• One resource provided by the NCTSN on
helping caregivers in planning a conversation
with their family using developmentally
appropriate language.
• Conversation topics can include:
• What the COVID-19 outbreak is
• How it is contracted
• What are the possible dangers
• Protective steps being taken in the community,
nation, global community
• Protective steps everyone in the family can take
(NCTSN, 2020)Resources for Children to Provide Additional Support
Resources from the National Child Traumatic Stress Network (NCTSN) for Families/Caregivers • Parent Caregiver Guide to Helping Families Cope with COVID-19: https://www.nctsn.org/resources/parent-caregiver-guide-to- helping-families-cope-with-the-coronavirus-disease-2019 • Simple Activities for Children and Adolescents: https://www.nctsn.org/resources/simple-activities-children-and- adolescents
Resources from the Center for the Study of
Traumatic Stress (CSTS)
• Discussing Coronavirus with Your Children:
https://www.cstsonline.org/assets/media/documents/CSTS_FS_Di
scussing_Coronavirus_w_Your_Children.pdf
• Finding the Right Words to Talk with Children and Teens about
COVID-19:
https://www.cstsonline.org/assets/media/documents/CSTS_FS_Fi
nding_Right_Words_Talk_Children_Teens_Coronavirus.pdf
• Taking Care of Family During Coronavirus:
https://www.cstsonline.org/assets/media/documents/CSTS_FS_Co
rona_Taking_Care_of_Your_Family.pdf.pdfOne Framework for Consideration
When people are facing stress and difficult life circumstances, it can
particularly affect three areas: a sense of safety, feelings of
connectedness and feelings of hope. In each of these areas,
educators and other workers can make an impact.
--From: A Trauma-Informed Approach to Teaching Through Coronavirus on the
Teaching Tolerance website of the Southern Poverty Law Center
https://bit.ly/2ULA39Y
Danna, Halladay-Goldman, Maze,
Ake, Pickens, 2020Impact on the Workforce
(Could be Applicable to Caregivers)
• Primary trauma: direct exposure to events
that involve a direct threat to the worker, or
witnessing threats to others.
• Moral distress: stress that occurs when one
believes they know the right thing to do, but
institutional or other constraints make it
difficult to pursue the desired course of action.
• Secondary traumatic stress: emotional
duress that results when an individual hears
about the firsthand traumatic experiences of
another.
(NCTSN, 2019)Note About Grief
• Acute grief reactions are likely to be intense and prevalent
among those who have suffered the death of a loved one or close
friend/colleague.
• May feel sadness and anger, guilt from not being able to prevent death,
regret about not providing comfort, and wishing for reunion.
• Strategies:
• Treat acutely bereaved children and adults with dignity, respect, and
compassion.
• Grief reactions are varied; no single “correct” course of or “normal” period
of time for grieving.
• Reassure that experience is understandable and expected.
(Brymer et al., 2006)Grief, contd.
• Traumatic Grief
• After traumatic death, some individuals may stay focused on the
circumstances of the death
• Examples: preoccupation with how death could have been prevented, what last moments
were like, who is at fault
• Traumatic stress reactions interfere with grieving, making it difficult to adjust to
death
• Examples: intrusive, disturbing images of the death; retreating from close relationships,
avoiding reminders of the death
• Strategies:
• Allow for initial strong reactions (i.e., numbness to agitation)
• Inform individual that if they continue to experience grief or depression that
affects daily functioning, may be helpful to talk to a clinician or member of the
clergy who specializes in grief.
(Brymer et al., 2006)Connectedness
• Goal: To help establish brief or ongoing contacts with primary
support persons and other sources of support, including family
members, friends, supervisors, and community helping resources.
• Strategies:
• Social distancing does not mean emotional distancing; given that we are
maintaining physical distance, we have to get creative with social
connection.
• Help individuals think about type of support that would be most helpful,
whom they can approach for that support
(Brymer et al., 2006)Enhancing Feelings of Hope
• Goal: To support individuals moving through this difficult time.
• How to determine what can and cannot be controlled.
• How can you foster hope in yourself and others?
• Ask a good friend or family member how he/she/they has maintained
hope during the pandemic or how you can look at things from a different
perspective.
• If watching news reports makes you feel hopeless, limit your intake of
media and/or social media.
• Practice gratitude individually or with family members.
(NCTSN, 2018)Caring for Yourself Awareness • Slow down and focus inward for a few moments • How are you feeling? What is your stress level? What thoughts are you noticing? Balance • Give yourself and your colleagues flexibility in managing multiple roles • Find balance of work, leisure, and rest Self-Care • Address basic needs: eat nutritious foods, stay hydrated, practice healthy sleep routines, stay active • Self-care should not be an independent task; lean in to your teams and find a “work buddy”
“True self-care is not about salt baths and chocolate cake, it is
making the choice to build a life you don’t regularly need to
escape from, and that often takes doing the things you least want
to do. It often means looking your failures and disappointments
square in the eye and re-strategizing. It is not satiating your
immediate desires. It is letting go. It is choosing new. It is
disappointing some people. It is making sacrifices for others. It is
living in a way that other people won’t. So maybe you can live in a
way that other people can’t.”
-Brianna WiestExamples of Self-Care Strategies
• Address basic needs: eat nutritious foods, stay hydrated, practice healthy sleep
routines, stay active
• Practice mindfulness or brief relaxation exercises while also allowing yourself to
have your own emotional responses
• Lean in to your teams and find a “work buddy” (i.e., self-care should not be a solely
independent task)
• Increase frequency of leisure activities: hobbies, journal, draw, paint
• Find meaning: practice religious faith, philosophy, and spirituality; journal, draw,
paint
• Maintain social connections in creative ways, while also addressing your boundaries
• Find time to laugh: watch funny videos, play a game
• Participate in formal help if extreme stress persists for greater than two to three
weeks
(NCTSN, 2018)References Brymer, M., et al. (2006). Psychological First Aid: Field Operations Guide. Retrieved from https://www.nctsn.org/sites/default/files/resources//pfa_field_operations_guide.pdf. Geronazzo-Alman, L., Eisenberg, R., Shen, S., Duarte, C. S., Musa, G. J., Wicks, J., ... & Hoven, C. W. (2017). Cumulative exposure to work-related traumatic events and current post-traumatic stress disorder in New York City's first responders. Comprehensive psychiatry, 74, 134-143. National Child Traumatic Stress Network (NCTSN). (2019). Secondary traumatic stress: Understanding the impact on professionals in trauma-exposed workplaces. Secondary Traumatic Stress Collaborative Group, NCTSN. Los Angeles, CA and Durham, NC: NCCTS. Teaching Tolerance. (2020). A trauma-informed approach to teaching through coronavirus. Retrieved from https://www.tolerance.org/magazine/a-trauma-informed-approach-to- teaching-through-coronavirus.
Framing the situation (Lieberman) What is happening to us? - This is unprecedented in our generation - Maybe most like the great depression - Differs depending on where you are, like climate change o Broad, pervasive, enduring effect o Don’t know how long it is going to last or when it will end o Will have substantial disruptive effects - “To name it is to tame it” - “The only thing to fear is fear itself” - Cognitive stance needs to be reframed to understand there are going to be wide ranging and long lasting effects.
Impacts - Getting through this is not a passive endeavor. It is an active process that requires a lot of work. - Besides getting sick, the panic and emotion has bigger impacts other than developing COVID-19. - The disruptive effects on the health system and social functioning are enormous. - Surge is overwhelming for doctors and health care systems - Significant economic impacts that will be long lasting.
Implications for individuals
- Everyone is going to be affected
- Those who pass, their loved ones, then out to the population as a
whole. Not just by the memory of the pandemic but jobs,
economics, employment, and what the world is going to be like in
the aftermath.
- Most people will get through it
- Others are more vulnerable to mental health challenges and will
need further treatment
- Types of responses
o Residual depression, mood and anxiety issues
o Response like trauma or PTSD
o Feelings of loss and grief. These you cannot medicate. You have to
manage the process and let it be completed
o Those who are angryWhat should we do? - Need a public mental health initiative to prepare for these responses - Society should be preparing for new mental health issues - Cognitive control over what we are experiencing may help process events, even if it is still hard to deal with it.
Implications for individuals - Children are affected by this, but adults are more so. - Parents are the vector by which they will experience stress to some extent. - Don’t catastrophize. Don’t watch the news 24/7. Don’t spend all day on the internet. - Put the oxygen mask on you first, then on others around you. Get control of your own mental health. - Plan how to deal with this. Proactively putting together a structure. - Reach out and get mental health assistance
Tips for high school and college students - Just remember, we WILL get through this - Might need to be flexible in plans. - Consider gap year or deferral, if that helps you feel more safe - Could be more virtual options available - Being creative in how families continue to celebrate milestones like graduation - We will have to adjust our expectations and realize that we are not alone - This isn’t fair or lucky.
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